What is groin pain?
The groin is the area of the hip between the stomach and thigh. The groin is made up of five muscles which work as a group to move the leg. These five muscles are: adductor brevis, adductor longus, adductor magnus, gracilis, and pectineus. Groin pain is any discomfort local to this area. It is usually the result of a strain injury which generally occur in sports.
What are some of the causes of groin pain?
The most common cause of groin pain is strain of the muscles, ligaments, or tendons located in the area of the groin. Playing a contact sport, which includes sports like rugby or football increases the chances that this type of injury will occur. An inguinal hernia is also a common cause of groin pain. It is when the abdominal tissues bulge through weaker areas of the groin muscles. It may result in a bump in the groin area and leave the individual in pain. Other causes can include kidney stones, or bone fractures. Less commonly, groin pain may be caused by: ovarian cysts, pinched nerves, urinary tract infections, swollen lymph nodes, or osteoarthritis of the hip.
Who and what can help with groin pain?
When treating groin pain caused by a strain, it is a good idea to see an exercise physiologist. This is a trained health professional who specialises in exercise and its effect on the body. They will be able to create a groin strengthening exercise rehabilitation program for someone with a groin sprain. The person with a groin sprain can begin by stretching their groin muscles immediately, however, they should be performed gently and stopped if there is any pain.
Some stretches which may be used are:
Hip adductor stretch:
- The stretch begins by lying on your back.
- Bend your knees and keep both feet flat on the floor.
- Gently spread your knees apart to stretch the inside of your thighs.
- Hold the stretch up to 30 seconds.
Hamstring stretch on wall:
- Begin by lying on your back with your buttocks near a doorway.
- Place your good leg straight out in front of your body, on the floor through the doorway.
- Raise your bad leg and place it up against the wall beside the door frame.
- Try to have your leg as straight as possible.
- The stretch should be felt at the back of your thigh.
- Hold this position for up to 30 seconds.
When groin pain has decreased, the following exercises may be performed:
Side-lying leg lift, cross over:
- Begin by lying on your bad side with your top leg bent and your foot placed in front of the bottom leg.
- Keep your bottom leg straight and raise your bad leg as far as possible without pain.
- Hold it for 5 seconds before lowering your leg slowly.
- Remember to keep your hips still when lifting your leg.
Straight leg raise:
- Begin by lying on your back with your legs placed out in front of you.
- Bend your knee on your good side and place your foot flat on the ground.
- Activate your thighs on your bad side and lift your leg off the floor.
- Try to maintain a straight leg and keep the thigh muscle tight.
- Slowly bring your leg back down to the ground.
When the above exercises become easier, the person may start groin strengthening exercise rehabilitation using resistance band exercises. These can be graded to be harder or easier with different level resistance bands, dependent on the strength of the muscles.
Groin strengthening exercise rehabilitation can include the following exercises:
Resisted hip flexion:
- Begin by standing facing away from a door.
- Tie a loop in one end of a piece of resistance band and place it around the ankle on your bad side.
- Tie a knot in the other end of the resistance band and trap the knot in the door close to the floor.
- Engage the front of your thigh and move the leg with the resistance band forward, maintain a straight leg.
- Bring your leg back to the first position.
- Begin by lying on your side with your legs, hips, and shoulders in a straight line.
- Bring yourself up on your forearm with your elbow placed directly under your shoulder.
- Lift your hips off the floor and balance on your forearm and your foot.
- Hold this position for up to 15 seconds before slowly lowering your hip back down to the ground.
- An exercise physiologist will help to grade this exercise to the ability of the person.
Resisted hip abduction:
- Begin by standing sideways near a door with your bad side furthest from the door.
- Tie a resistance band around the ankle on your bad side, tie the other end and trap it in the door near the floor.
- Pull the band out to the side while maintaining a straight leg.
- Bring your leg back to the starting position.
- To increase resistance, start further away from the door.
Resisted hip adduction:
- Stand sideways beside a door with your bad side closest to the door.
- Make a knot at one end of the resistance band and place the knot around the ankle on your bad side. Make another knot in the other end of the band and place the knot in the door near the floor.
- Bring the leg with the band across your body sideways, crossing the other leg and stretching the band.
- Bring your leg back to the starting position.
Along with groin strengthening exercise rehabilitation, a person with groin pain may benefit from hands-on treatment. When the sprain occurs, muscles, tendons, or ligaments are stretched, compromising structures of the body. To cope with this, surrounding structures will tighten up. The tension in the muscles causes increased pain for an individual additional to the pain of the strain. The tightened muscles will also make the sprain worse by pulling on the muscles of the groin and increasing their stretch. A soft tissue occupational therapist will treat the tight muscles.
A soft tissue occupational therapist is specialised in the treatment of soft tissue injuries and conditions. Soft tissue refers to muscles, ligaments, tendons, and fascia. The types of injuries an occupational therapist will treat are vast and caused by a variety of factors. Car accidents, injuries on a sports field, and other traumatic injuries, or slow onset degenerative and years of poor posture, high emotional stress, and hormonal changes, all come under the scope of soft tissue occupational therapy treatment. The soft tissue occupational therapist will use a hands-on approach to manage and cure pain, correct body alignment, and return the person to their normal function, improving their quality of life.
This hands-on treatment approach is called myofascial release or trigger point therapy. The therapist will palpate or feel areas of the muscle to locate areas of tension. They will then apply a firm sustained pressure to the hyper-irritable spot of the muscle, which is called a trigger point, and remove the tension from the area. The way this treatment works is when the therapist applies pressure to a spot, there is a restriction of blood flow to the area, and then when the pressure is released, blood flow rushes back into the area bringing new oxygenated blood full of nutrients to that area of the muscle and at the same time removes toxins which were stored in the muscle. This treatment adds length to tight muscles and decreases pressure and the pain generated by trigger points. In some cases trigger points cause pain in other parts of the body and are not limited to the area they are located, this is what is known as referral pain.
For a groin sprain the soft tissue occupational therapist will treat through the hip adductor muscles and will also treat the surrounding structures including muscles in the thigh. The therapist will start by completing assessments to see which muscles have been affected. The therapist may perform a postural assessment to see if the body’s alignment has changed to suggest which structures have tightened, and palpate and feel the muscles themselves to find the exact locations of trigger points. The therapist may also get you to complete a range of motion exercise before treatment and after treatment is completed, to see if movement has been restored or increased. The soft tissue occupational therapist will also be able to recommend stretches and exercises to complete at home, and refer to an exercise physiologist when necessary. Seeing a soft tissue occupational therapist can help to improve healing time from a groin injury as well as provide pain management for the person with groin pain. Regular treatment can also offset lifestyle factors which result in constant injuries and recurring pain, and improve the functioning of the body to decrease the risk of future injuries, while improving performance in sports and daily activities.
At Infused Health our highly trained Exercise Physiologist and Soft Tissue Occupational Therapists will use their knowledge and skill to help treat your injuries, conditions or any concerns you may have. You can make an appointment today by calling 0401 876 623.
Image retrieved from: Davis-Monathan Air Force Base